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1.
J Refract Surg ; 40(6): e371-e380, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38848054

RESUMO

PURPOSE: To report on the prospective evaluation of photorefractive keratectomy (PRK) in experienced ametropic naval aviators that led to the approval of refractive surgery for military pilots. METHODS: This was the first study evaluating refractive surgery in naval aviators. Return to flight status after PRK and clinical outcomes and subjective and objective flight performance were evaluated. RESULTS: A total of 785 U.S. naval aviators were enrolled in the study. Average preoperative refraction was -2.92 ± 1.73 diopters (D) (range: +5.25 to -9.13 D). By 6 months, 85.9% of eyes were within ±0.50 D and 96.4% were within ±1.00 D of emmetropia. 94.4% of eyes achieved 20/20 or better, 74.3% had 20/16 or better, and 45.2% had 20/12.5 or better uncorrected distance visual acuity (UDVA) at 6 months. A total of 78.5% of aviators met return-to-flight criteria by 4 weeks, 83.3% by 8 weeks, and 90.8% by 12 weeks following PRK. All aviators eventually returned to full flight status. Cumulative flight experience included logging more than 48,000 flight hours and 19,500 landings in the 6 months following PRK. Psychometric questionnaire results showed that 78% reported improved ability to detect other aircraft and 92% reported improved ability to land on an aircraft carrier (82% significantly improved) compared to wearing corrective lenses. No one felt their vision was worse in these dynamic environments. All aviators indicated they would undergo the procedure again and would recommend it to a fellow aviator. CONCLUSIONS: This prospective study in U.S. naval aviators determined PRK to be safe and effective in a unique patient population operating in a visually demanding and hazardous environment. The program continues to be enthusiastically supported by aviators and PRK is now allowed in all branches of the military and for National Aeronautics and Space Administration astronauts. [J Refract Surg. 2024;40(6):e371-e380.].


Assuntos
Lasers de Excimer , Militares , Miopia , Ceratectomia Fotorrefrativa , Refração Ocular , Acuidade Visual , Ceratectomia Fotorrefrativa/métodos , Humanos , Estudos Prospectivos , Acuidade Visual/fisiologia , Adulto , Masculino , Estados Unidos , Feminino , Miopia/cirurgia , Miopia/fisiopatologia , Lasers de Excimer/uso terapêutico , Refração Ocular/fisiologia , Adulto Jovem , Pessoa de Meia-Idade , Medicina Aeroespacial , Resultado do Tratamento
2.
Stress ; 27(1): 2361253, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38859613

RESUMO

Commercial pilots endure multiple stressors in their daily and occupational lives which are detrimental to psychological well-being and cognitive functioning. The Quick coherence technique (QCT) is an effective intervention tool to improve stress resilience and psychophysiological balance based on a five-minute paced breathing exercise with heart rate variability (HRV) biofeedback. The current research reports on the application of QCT training within an international airline to improve commercial pilots' psychological health and support cognitive functions. Forty-four commercial pilots volunteered in a one-month training programme to practise self-regulated QCT in day-to-day life and flight operations. Pilots' stress index, HRV time-domain and frequency-domain parameters were collected to examine the influence of QCT practice on the stress resilience process. The results demonstrated that the QCT improved psychophysiological indicators associated with stress resilience and cognitive functions, in both day-to-day life and flight operation settings. HRV fluctuations, as measured through changes in RMSSD and LF/HF, revealed that the resilience processes were primarily controlled by the sympathetic nervous system activities that are important in promoting pilots' energy mobilization and cognitive functions, thus QCT has huge potential in facilitating flight performance and aviation safety. These findings provide scientific evidence for implementing QCT as an effective mental support programme and controlled rest strategy to improve pilots' psychological health, stress management, and operational performance.


Assuntos
Exercícios Respiratórios , Cognição , Frequência Cardíaca , Pilotos , Humanos , Frequência Cardíaca/fisiologia , Masculino , Adulto , Cognição/fisiologia , Pilotos/psicologia , Exercícios Respiratórios/métodos , Estresse Ocupacional/psicologia , Estresse Psicológico/psicologia , Estresse Psicológico/fisiopatologia , Feminino , Biorretroalimentação Psicológica , Pessoa de Meia-Idade , Resiliência Psicológica , Medicina Aeroespacial
3.
Aerosp Med Hum Perform ; 95(5): 233-244, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38715263

RESUMO

INTRODUCTION: Cardiovascular (CV) diseases are a major public health issue, the prevention of which plays a key role in promoting flight safety. However, few studies have looked at the determinants of the overall risk of CV morbidity-mortality within the various aeronautical occupations.METHODS: A monocentric, observational, cross-sectional study was based on the retrospective data collected during 6 mo at the Toulon Aeromedical Center. From October 2017 to April 2018, 2792 professional aircrew ages 18-74 were included. The overall CV risk was estimated using the European Society of Cardiology SCORE and the Framingham model, as well as a summation model.RESULTS: More than two-thirds of this mainly male population (86.2%) had no more than one CV risk factor [69.9% (68.2-71.6)]. In 82.5% of cases, this was dyslipidemia according to current European criteria [55.8% (52.4-59.1)] or smoking [26.7% (23.8-29.8)]. An overall risk level of "moderate" to "very high" concerned only one subject in five according to the SCORE model [20.1% (18.6-21.6)], one in six according to Framingham [16.3% (14.9-17.7)] and almost one in three according to the summation model [30.1% (28.4-31.9)].DISCUSSION: Multivariate analyses found no significant associations between socio-professional criteria and overall risk levels. The results have underlined the effect of dyslipidemia and smoking on early risk among applicants. Beyond the illustration of favorable cardiovascular status among aircrews related to the standards of selection and close monitoring process, areas for improvement were identified, inviting the development of prevention strategies around the "moderate" overall CV risk.Huiban N, Gehant M, Brocq F-X, Collange F, Mayet A, Monteil M. Global cardiovascular risk and associated factors in 2792 French military and civilian aircrew. Aerosp Med Hum Perform. 2024; 95(5):233-244.


Assuntos
Doenças Cardiovasculares , Fatores de Risco de Doenças Cardíacas , Militares , Pilotos , Humanos , Masculino , Adulto , Estudos Transversais , França/epidemiologia , Pessoa de Meia-Idade , Doenças Cardiovasculares/epidemiologia , Militares/estatística & dados numéricos , Estudos Retrospectivos , Feminino , Idoso , Adolescente , Adulto Jovem , Pilotos/estatística & dados numéricos , Medicina Aeroespacial , Fatores de Risco , Fumar/epidemiologia , Dislipidemias/epidemiologia
4.
Aerosp Med Hum Perform ; 95(6): 337-340, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38790118

RESUMO

BACKGROUND: Functional dyspepsia is a disorder of gut-brain interaction that has the potential to impact aviation performance. Proton pump inhibitors are well-tolerated but are only effective in one half of cases. Second-line treatments, including tricyclic antidepressants, are associated with drowsiness and are not routinely approved for use in aviators. We present a case of a Naval Flight Officer with functional dyspepsia who was successfully treated with amitriptyline and returned to flying status.CASE REPORT: A 23-yr-old male Naval Flight Officer presented with postprandial fullness and epigastric pain. His symptoms were refractory to trials of acid suppression and lifestyle modification. An extensive evaluation by Gastroenterology, including upper endoscopy, did not reveal an organic cause of his symptoms and he was diagnosed with functional dyspepsia. The patient's symptoms resolved with a trial of amitriptyline. Neuropsychological testing demonstrated no medication effect on cognitive performance. A waiver to resume flying duties on amitriptyline was submitted to the Naval Aerospace Medical Institute and was approved.DISCUSSION: We present the second known waiver issued in U.S. Naval aviation history for the use of amitriptyline to treat a gastrointestinal disorder. Amitriptyline is not commonly waived due to the potential for unacceptable cognitive side-effects in the flight environment. However, neuropsychological testing to assess for a possible medication effect on performance can be used to inform an aeromedical disposition and, in this case, allowed for a return to flight status.Crutcher R, Kolasinski N. Functional dyspepsia and tricyclic antidepressant use in a naval flight officer. Aerosp Med Hum Perform. 2024; 95(6):337-340.


Assuntos
Medicina Aeroespacial , Amitriptilina , Antidepressivos Tricíclicos , Dispepsia , Militares , Humanos , Masculino , Antidepressivos Tricíclicos/uso terapêutico , Dispepsia/tratamento farmacológico , Amitriptilina/uso terapêutico , Adulto Jovem
5.
Aerosp Med Hum Perform ; 95(6): 333-336, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38790123

RESUMO

BACKGROUND: In the literature, central serous retinopathy (CSR) accompanying solitary fibrous tumors (SFT) in a pilot has not been reported. In airline pilots, mass effect-related symptoms such as diplopia, ptosis, etc., seen with orbital tumors may endanger flight safety.CASE REPORT: A 62-yr-old male commercial airline pilot presented with blurred vision in the right eye. He had been receiving treatment for 2 mo because of CSR. His visual acuity was 10/20 in the right eye and 20/20 in the left. During examination, ptosis and exophthalmos were noticed in the right eye. Ocular movements were free in all cardinal directions and there was downward displacement in the right eye. There was no diplopia. Magnetic resonance imaging revealed a 1.5- to 2-cm well-defined contrast-enhancing mass in the lateral extraconal orbit. His medical flight certificate was suspended for 3 mo due to decreased visual acuity and superior visual defect. Superior orbitotomy was performed without any complication. Ptosis and CSR had regressed 1 wk after surgery. All systemic and ophthalmological examinations met aviation medical certificate requirements. He returned to flight on the condition of being checked every 3 mo. At the 1-yr follow-up, there was no sign of recurrences of SFT or CSR.DISCUSSION: SFTs are slow-growing neoplasms that can manifest symptoms related to mass effect. In the current literature, there are no reported cases of the coexistence of orbital SFT and CSR or pilots able to resume flight duties only 1 wk after a successful orbitotomy and tumor resection surgery.Altinbas M, Ozpinar A, Akbaba M, Nacaroglu SA, Sargolzaeimoghaddam M, Sargolzaeimoghaddam M. Orbital solitary fibrous tumor in a commercial airline pilot. Aerosp Med Hum Perform. 2024; 95(6):333-336.


Assuntos
Medicina Aeroespacial , Imageamento por Ressonância Magnética , Neoplasias Orbitárias , Pilotos , Tumores Fibrosos Solitários , Humanos , Masculino , Tumores Fibrosos Solitários/cirurgia , Tumores Fibrosos Solitários/diagnóstico por imagem , Tumores Fibrosos Solitários/diagnóstico , Pessoa de Meia-Idade , Neoplasias Orbitárias/cirurgia , Neoplasias Orbitárias/diagnóstico por imagem , Neoplasias Orbitárias/diagnóstico , Acuidade Visual/fisiologia , Transtornos da Visão/etiologia
8.
Aerosp Med Hum Perform ; 95(6): 327-332, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38790129

RESUMO

INTRODUCTION: The absence of a consistent downward G vector can make separation of gases from liquids challenging, such as in field medicine without stable upright equipment or during spaceflight. This limits the use of medical equipment and procedures like administration of intravenous (IV) fluids in microgravity and can make field medicine hazardous. Administering IV fluids and medications in microgravity requires a technique to separate air from the liquid phase. Current commercial filters for separation of gases are incompatible with high flow and blood. We present a novel filter designed to provide adequate air clearance without a consistent downward G vector.METHODS: Inline air-eliminating filters were designed for use with IV fluid tubing in microgravity using computer-aided design software and printed using nylon 12 on an EOS Selective Laser Sintering 3D printer. A 0.2-µm membrane filter was adhered around a central, hollow pillar with external spiral baffles allowing separation and venting of air from the fluid. Results were compared against commercially available inline air-eliminating filters.RESULTS: The 3D-printed filters outperformed the commercial filters in both percentage of air removed and flow rates. The centrifugal, baffled filter had flow rates that far exceeded the commercial filters during rapid transfusion.DISCUSSION: IV fluid administration is an often underappreciated and a necessary basic requirement for medical treatment. An air-eliminating filter compatible with blood and rapid transfusion was developed and validated with crystalloid solutions to allow the successful administration of IV fluid and medication without a consistent downward G vector.Formanek A, Townsend J, Ottensmeyer MP, Kamine TH. A novel 3D-printed gravity-independent air-eliminating filter for rapid intravenous infusions. Aerosp Med Hum Perform. 2024; 95(6):327-332.


Assuntos
Desenho de Equipamento , Impressão Tridimensional , Humanos , Infusões Intravenosas/instrumentação , Filtração/instrumentação , Medicina Aeroespacial , Ausência de Peso , Gravitação , Desenho Assistido por Computador
9.
Aerosp Med Hum Perform ; 95(6): 290-296, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38790126

RESUMO

INTRODUCTION: Modafinil is used as a countermeasure to limit the effects of fatigue in military aviation. However, literature is conflicting about its negative effects on subsequent sleep.METHODS: This randomized placebo-controlled trial conducted by the Center of Man in Aviation of the Royal Netherlands Airforce is part of a larger study. It included 32 subjects (mean age 35 yr old, 84% male) who followed a normal daily routine and stayed awake the subsequent night. At midnight, all subjects received either 300 mg caffeine, 200 mg modafinil, or placebo. At the end of the test night, subjects were awake for a median period of 26 h. Afterwards, sleep questionnaires containing qualitative (Groningen Sleep Quality Scale) and quantitative parameters of sleep for the subsequent day (recovery sleep) and consecutive night (post-test sleep) were completed and statistically analyzed using Friedman and Wilcoxon signed rank tests.RESULTS: A statistically significant difference in the reported recovery sleep was observed. The modafinil group slept 30% shorter than placebo, but sleep efficiency was not statistically different. Quantitatively post-test sleep did not vary statistically significantly between the three groups. However, Groningen Sleep Quality Scale scores were lower post-test than pre-test in the modafinil group, while this was not the case in the caffeine and placebo group.DISCUSSION:This study found that modafinil subjectively does not negatively impact recovery sleep or subsequent nighttime sleep after an extended period of wakefulness and suggests it may decrease the need for recovery sleep compared to placebo or caffeine.Wingelaar-Jagt YQ, Wingelaar TT, Riedel WJ, Ramaekers JG. Modafinil subjectively does not impair sleep in aviators after a period of extended wakefulness. Aerosp Med Hum Perform. 2024; 95(6):290-296.


Assuntos
Cafeína , Modafinila , Promotores da Vigília , Vigília , Humanos , Masculino , Adulto , Vigília/efeitos dos fármacos , Vigília/fisiologia , Promotores da Vigília/uso terapêutico , Cafeína/administração & dosagem , Feminino , Militares , Sono/efeitos dos fármacos , Sono/fisiologia , Método Duplo-Cego , Pilotos , Medicina Aeroespacial , Qualidade do Sono , Compostos Benzidrílicos/uso terapêutico , Fadiga/tratamento farmacológico , Fadiga/fisiopatologia
10.
Aerosp Med Hum Perform ; 95(6): 341-343, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38790128
11.
Aerosp Med Hum Perform ; 95(6): 321-326, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38790131

RESUMO

INTRODUCTION: On-board medical emergencies are increasing. Different geographies have different legislation and requirements for medical emergency kits and first aid kits. A comprehensive review to compare the contents of both kits was conducted, including the International Air Transport Association, European Union Aviation Safety Agency, and Federal Aviation Administration, as well as some from other geographical areas of the globe to cover continents and regions with the highest air traffic, such as Brazil, Kenya, Australia, and Taiwan.METHODS: On June 10, 2023, a search was conducted using standardized medical terms (medical subject headings) within the PubMed® database. The relevant terms identified were "Aircraft" and "Medical Emergencies"; articles published within the last 10 yr were filtered. Subsequently, even articles published before 2013 were consulted if cited by the initial ones. The main regulatory entities' documentation was found using the Google search engine and consulted.CONCLUSIONS: It is impossible to be prepared for every emergency on board. Still, as doctors, we have a moral and ethical obligation to try to improve the outcomes of those emergencies. Getting a standardized report of every on-board emergency is crucial. That would make optimizing the items to include in the emergency and first aid kits easier. There are many similarities among the compared entities, but essential differences have been found. There is room for improvement, especially for pediatric travelers.Oliveira ATB. Worldwide regulation of the medical emergency kit and first aid kit. Aerosp Med Hum Perform. 2024; 95(6):321-326.


Assuntos
Primeiros Socorros , Humanos , Aeronaves , Emergências , Serviços Médicos de Emergência/legislação & jurisprudência , Medicina Aeroespacial/legislação & jurisprudência
12.
Metabolomics ; 20(3): 63, 2024 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-38796596

RESUMO

INTRODUCTION: Fighter pilots must support the effects of many stressors, including physical and psychological exertion, circadian disturbance, jet lag, and environmental stress. Despite the rigorous selection of military pilots, those factors predispose to failures in physiological compensatory mechanisms and metabolic flexibility. OBJECTIVES: We compared through NMR-based metabolomics the metabolic profile of Brazilian F5 fighter pilots with different flight experiences vs. the control group of non-pilots. We hypothesized that combat pilots have metabolic flexibility associated with combat flight time. METHODS: We evaluated for the first time 34 Brazilian fighter pilots from Santa Cruz Air Base (Rio de Janeiro, RJ) allocated into three groups: pilots with lower total accumulated flight experience < 1,100 h (PC1, n = 7); pilots with higher total accumulated flight experience ≥ 1,100 h (PC2, n = 6); military non-pilots (CONT, n = 21). Data collection included anthropometric measurements, total blood count, lipidogram, markers of oxidative stress, and serum NMR-based metabolomics. RESULTS: In comparison with controls (p < 0.05), pilots exhibited decreased levels of white blood cells (-13%), neutrophils (-15%), lymphocytes (-20%), alfa-glucose (-13%), lactate (-26%), glutamine (-11%), histidine (-20%), and tyrosine (-11%), but higher isobutyrate (+ 10%) concentrations. Significant correlations were found between lactate vs. amino acids in CONT (r = 0.55-0.68, p < 0.001), and vs. glutamine in PC2 (r = 0.94, p = 0.01). CONCLUSION: Fighter pilots with lower experience showed a dysregulation in immune-metabolic function in comparison with controls, which seemed to be counteracted by the accumulation of flight hours. Those findings might have implications for the health preservation and operational training of fighter pilots.


Assuntos
Militares , Pilotos , Humanos , Brasil , Masculino , Adulto , Metabolômica/métodos , Metaboloma/fisiologia , Estresse Oxidativo/fisiologia , Espectroscopia de Ressonância Magnética/métodos , Medicina Aeroespacial
13.
Medicina (Kaunas) ; 60(5)2024 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-38792866

RESUMO

In-flight medical incidents are becoming increasingly critical as passengers with diverse health profiles increase in the skies. In this paper, we reviewed how airlines, aviation authorities, and healthcare professionals respond to such emergencies. The analysis was focused on the strategies developed by the top ten airlines in the world by examining training in basic first aid, collaboration with ground-based medical support, and use of onboard medical equipment. Appropriate training of crew members, availability of adequate medical resources on board airplanes, and improved capabilities of dialogue between a flying plane and medical doctors on the ground will contribute to a positive outcome of the majority of medical issues on board airlines. In this respect, the adoption of advanced telemedicine solutions and the improvement of real-time teleconsultations between aircraft and ground-based professionals can represent the future of aviation medicine, offering more safety and peace of mind to passengers in case of medical problems during a flight.


Assuntos
Aeronaves , Emergências , Humanos , Medicina Aeroespacial/métodos , Telemedicina/tendências , Serviços Médicos de Emergência/métodos , Serviços Médicos de Emergência/normas , Primeiros Socorros/métodos , Aviação
14.
Aerosp Med Hum Perform ; 95(5): 231-232, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38715262
15.
Aerosp Med Hum Perform ; 95(5): 273-277, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38715261

RESUMO

INTRODUCTION: There is a current belief in aviation suggesting that aerobic training may reduce G-tolerance due to potential negative impacts on arterial pressure response. Studies indicate that increasing maximal aerobic capacity (V˙o2 max) through aerobic training does not hinder G-tolerance. Moreover, sustained centrifuge training programs revealed no instances where excessive aerobic exercise compromised a trainee's ability to complete target profiles. The purpose of this review article is to examine the current research in the hope of establishing the need for routine V˙o2-max testing in air force pilot protocols.METHODS: A systematic search of electronic databases including Google Scholar, PubMed, the Aerospace Medical Association, and Military Medicine was conducted. Keywords related to "human performance," "Air Force fighter pilots," "aerobic function," and "maximal aerobic capacity" were used in various combinations. Articles addressing exercise physiology, G-tolerance, physical training, and fighter pilot maneuvers related to human performance were considered. No primary data collection involving human subjects was conducted; therefore, ethical approval was not required.RESULTS: The V˙o2-max test provides essential information regarding a pilot's ability to handle increased Gz-load. It assists in predicting G-induced loss of consciousness by assessing anti-G straining maneuver performance and heart rate variables during increased G-load.DISCUSSION: V˙o2-max testing guides tailored exercise plans, optimizes cardiovascular health, and disproves the notion that aerobic training hampers G-tolerance. Its inclusion in air force protocols could boost readiness, reduce health risks, and refine training for fighter pilots' safety and performance. This evidence-backed approach supports integrating V˙o2-max testing for insights into fitness, risks, and tailored exercise.Zeigler Z, Acevedo AM. Re-evaluating the need for routine maximal aerobic capacity testing within fighter pilots. Aerosp Med Hum Perform. 2024; 95(5):273-277.


Assuntos
Militares , Pilotos , Humanos , Medicina Aeroespacial , Tolerância ao Exercício/fisiologia , Consumo de Oxigênio/fisiologia , Exercício Físico/fisiologia , Teste de Esforço/métodos , Centrifugação , Gravitação
16.
Aerosp Med Hum Perform ; 95(5): 265-272, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38715267

RESUMO

INTRODUCTION: Employees from any type of aviation services industry were asked to give their opinions about the usefulness of consumer sleep technologies (CSTs) during operations and their willingness to share data from CSTs with their organizations for fatigue risk management purposes under a variety of circumstances.METHODS: Respondents provided information about position in aviation and use of CST devices. Respondents ranked sleep issues and feedback metrics by perceived level of importance to operational performance. Respondents rated their likelihood to share data with their organization under a series of hypothetical situations.RESULTS: Between January-July 2023, 149 (N = 149) aviation professionals responded. Pilots comprised 72% (N = 108) of respondents; 84% (N = 125) of all respondents worked short- or medium-haul operations. "Nighttime operations" and "inconsistent sleep routines" ranked as the most important issues affecting sleep. "Sleep quality history" and "projected alertness levels" ranked as most important feedback metrics for personal management of fatigue. Respondents were split between CST users (N = 64) and nonusers (N = 68). CST users did not indicate a strong preference for a specific device brand. The most-reported reason for not using a CST was due to not owning one or no perceived need. Respondents indicated greater likelihood of data sharing under conditions where the device was provided to them by their organization.DISCUSSION: These results suggest that aviation professionals are more concerned about schedule-related disturbances to sleep than they are about endogenous sleep problems. Organizations may be able to increase compliance to data collection for fatigue risk management by providing employees with company-owned CSTs of any brand.Devine JK, Choynowski J, Hursh SR. Fatigue risk management preferences for consumer sleep technologies and data sharing in aviation. Aerosp Med Hum Perform. 2024; 95(5):265-272.


Assuntos
Aviação , Fadiga , Gestão de Riscos , Humanos , Adulto , Masculino , Feminino , Pessoa de Meia-Idade , Disseminação de Informação , Medicina Aeroespacial , Inquéritos e Questionários , Pilotos , Sono/fisiologia
17.
Aerosp Med Hum Perform ; 95(5): 282-285, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38715268
18.
Aerosp Med Hum Perform ; 95(5): ii, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38715269
19.
Aerosp Med Hum Perform ; 95(5): 1-71, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38715270
20.
Aerosp Med Hum Perform ; 95(5): iii-iv, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38715271
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